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Back pain

Get fast access to effective treatment for back pain in Harrow

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Many people get acute back pain that subsides within days or weeks without needing more than a few days’ rest and self-help, such as a hot or cold pack and taking a painkiller.

But if an episode of back pain happens frequently, the pain has not subsided, or your back is not working as it should, you can make an appointment to see a back pain specialist quickly at The Clementine Churchill Hospital in Harrow.

Whether you come to us from your GP, a physiotherapist, a musculoskeletal (MSK) clinic or any other route, you can access swift advice, diagnosis and bespoke treatments for back pain problems.

Although back pain can be frightening when it happens, it does not always mean that surgery is required. Most issues are due to muscular strains or sprains that benefit from improved posture, pain relief, applying hot or cold to the area, massage or physiotherapy.

However, if you want specialist advice or your back pain doesn’t ease, The Clementine Churchill Hospital and Circle Health Group can help. Our back pain specialists can create a care plan that gets you mobile again, including medication, muscle relaxants, physical therapy, steroid injections or surgery as a last resort.

Our experts cover every type of back pain and include consultant spinal orthopaedic and neurosurgeons as well as rheumatologists.

Structural back pain describes a change in the way the components of the back fit together or move. The backbone (spinal column or vertebral column) is made up of 24 vertebrae (individual, interlocking bones).

Seven vertebrae are in the upper (cervical) areas. Twelve are in the middle (thoracic), and five are in the lower (lumbar) spine. The fused vertebrae, called the sacrum (sacral spine), are connected to the lower lumbar spine, and the coccyx (tailbone) lies below the sacrum.

A spinal disc (intervertebral disc) between each vertebra acts as a shock absorber. Facet joints on the left and right of each vertebral section help to stabilise the spine when it moves.

Spinal ligaments, muscles, and tendons support and strengthen the spine, vertebrae, discs and facet joints.

Back pain is usually ‘non-specific’. Your consultant may refer to it as lower back pain, called lumbago.

Mrs Anne Mitchener, a Consultant Neurosurgeon at The Clementine Churchill Hospital, said: “Non-specific back pain is when we can’t identify the structural cause. Specific back pain is due to an identifiable cause, whether that’s structural or metabolic, meaning a medical condition like arthritis.”

Other specific causes are a slipped (herniated) disc, facet joint pain or a ligament issue.

Lower back pain is the most common cause of discomfort as it takes the brunt of our weight and movement. Low back pain can also be related to other problems elsewhere in the body, such as the kidneys or bowel. If you have another condition, it could be related to your back pain — a back pain specialist will be able to tell you.

Mrs Mitchener said, “As part of low back pain, we see some sacral and coccygeal pathologies (the sacrum is at the bottom of your pelvis, and the coccyx is the tailbone). We don’t know why people get coccygeal pain. But a possible cause of people having sacral pain is a bowel condition like Crohn’s disease or a medical condition like osteoarthritis.

“Other patients who have had spinal lower lumbar fusion surgery can experience strain on the sacroiliac joint. Another cause is ageing bones that fracture in the sacrum.”

At The Clementine Churchill Hospital, our surgeons also see significant neck pain and symptoms of neck degeneration.

If the reason for your back pain is something wrong with your spine or muscles in your back, it’s called mechanical back pain.

Stress is placed on the spine’s joints, discs and vertebrae, causing muscle and soft tissue pain. Mechanical back pain is often experienced in your lower back, but you may feel it in the pelvis, buttocks and thighs.

Instability can also come from an imbalance of the musculoskeletal structure, such as the hips, causing the muscles to compensate.

Non-specific mechanical back pain could be due to being overweight and inactive, standing or sitting for too long, lifting something awkwardly or even being stressed. Typical starting therapies include manual therapy (massage), physiotherapy, exercise, and acupuncture.

Your consultant at The Clementine Churchill Hospital may refer to two main back pain types — acute and chronic back pain.

Acute back pain

With acute back pain, the pain is sudden and lasts for a short time but gradually subsides. Around 90% of attacks of acute back pain settle within six weeks.

Chronic back pain

If you have chronic back pain, the discomfort is most often felt in the lower back. The pain will be severe and ongoing for more than three months.

You may notice back pain symptoms in your lower back, but it can spread to other areas of the muscles, joints and soft tissues around the spine.

Common  back pain symptoms include:

  • Lower back pain or ache
  • Spasms when lifting or flexing the back
  • Stiffness in the morning
  • Pins and needles
  • Shooting pains down the leg or buttock
  • Difficulty standing upright without pain

Most of the time, back pain will improve — it isn’t usually anything to worry about. The most common type of back pain — lower back pain —  generally goes away after a few days or weeks.

However, if you experience symptoms such as tingling, weakness or numbness in the legs or groin, a fever,  an inability to control your bowel or bladder, or unexplained weight loss, you should see a doctor straight away. This may indicate something more serious.

Most lower back pain is caused by straining (pulling) the muscles and tendons and structural problems in the bones, joints, vertebrae, and discs between each vertebra, ligaments, nerves and tendons.

Low back pain could also be due to an injury such as a compression fracture, prolapsed disc, arthritic conditions, or infection, which a consultant orthopaedic surgeon or spinal neurosurgeon needs to identify.

Mrs Mitchener said: “Patients at The Clementine Churchill Hospital often present with degenerate lumbar spine or disc disease. More than the discs degenerate; the facet joint can degenerate, too.

“It could be because of disc herniation (prolapse), facet joint degeneration, or canal stenosis, which is usually due to both above and ligamentous thickening. The ligament is like the carpet liner of the spinal canal, and it thickens with age.”

You can treat most immediate back sprains and strains at home with rest and ice, which reduces swelling, inflammation, and pain.

  • Rest – try to rest for a few days and stop any exercises or activities that stress the back but do not be inactive for too long as the back likes movement.
  • Ice – use an ice pack wrapped in a towel to reduce inflammation. Apply it to the area of the back that hurts for 15–20 minutes every two hours. After 72 hours, change to a heat pack to help increase circulation and release muscle tension.

If you have muscle spasms, your doctor may prescribe a muscle relaxant or suggest physical therapy such as massage or a trained physiotherapist.

They may also refer you to a specialist such as a rheumatologist or an orthopaedic surgeon.

At The Clementine Churchill Hospital, the most typical structural lower back pain conditions are slipped (prolapsed or herniated) discs and nerve compression.

Slipped disc

A slipped disc is one of the most common reasons people book an appointment with a back specialist at The Clementine Churchill Hospital and Circle Health Group. It is typically caused by wear and tear as we age.

“However, we also see young people with disc prolapse and herniation and middle-aged people with them,” said Mrs Mitchener.

When you have a slipped disc, the tissue between the bones bulges out and presses on the nerve roots. The results are lower back pain or neck pain, numbness and tingling, difficulty straightening or bending the back, and sometimes sciatica (the disc presses on the sciatic nerve causing pain in the buttocks, hips or legs).

Narrowing of the spine (spinal stenosis)

A herniated disc or spinal osteoarthritis can cause the spaces around the spinal cord to narrow, compressing the nerves and making walking painful.

Nerve compression occurs mainly in older people. It primarily affects the lower back, and the symptoms include leg weakness, difficulty balancing, numbness or burning in the buttocks, and difficulty lifting the foot.

Your consultant at The Clementine Churchill Hospital may suggest lumbar spinal decompression surgery if non-surgical methods such as painkillers have not relieved it.

Sciatica

Sciatica is a burning pain that radiates from the spine down the buttocks to the leg and is due to pressure on the nerve root. It’s typically caused by a disc problem or general wear and tear.

The pain you get in the arm, the equivalent of sciatica is called brachialgia — a term spinal surgeons use. A trapped nerve in the neck causes it.

Your spinal consultant may recommend spinal injections for sciatica before exploring surgical options.

Spinal osteoarthritis (spondylosis)

Around nine million people in the UK have osteoarthritis, which happens most often in people from 45 or older (although you can get it when you’re younger).

Spinal osteoarthritis is a long-term degenerative condition in which the spine’s joints, discs and bones wear down and cause inflammation and bone spur (osteophyte) growth.

Your spinal surgeon at The Clementine Churchill Hospital may call the condition spondylosis.

Osteoporosis

is a painful condition where the bones lose density resulting in vertebrae fractures, also known as compression fractures. Thinning bones is a structural change, and osteopenia is when bone begins to thin.

Spondylolisthesis

Mrs Mitchener explains, “With spondylolisthesis, there is specific slip of one vertebra on another. It can be a sideways or a front-to-back slip, and it can cause a curvature of the spine (scoliosis) to develop. Scoliosis is a form of mechanical back pain but can also be congenital.”

Scoliosis (curvature of the spine)

Our consultants regularly treat people for scoliosis, where the lateral curvature of the spine is twisted and curved. The skilled surgery required by the orthopaedic surgeon or neurosurgeon involves correcting and straightening the curvature.

Rheumatoid arthritis

At The Clementine, we treat many patients for rheumatoid arthritis, where the immune system attacks and destroys the joints. A specific form of arthritis affecting the back is ankylosing spondylitis.

It is rare for back pain to signal a severe issue such as cancer. However, certain signs indicate the need for immediate medical attention. They are:

  • Unexplained loss of weight
  • Intense pain worsens at night
  • Difficulty controlling bladder or bowel
  • Weakness of a limb
  • Numbness in the limb
  • Numbness in the saddle region (which could indicate cauda equina syndrome, which is a medical emergency)
  • Chest pain (could indicate a heart attack)
  • Fever and chills (could indicate infection)

If the back pain follows a traumatic injury such as a traffic accident, you should call for an ambulance or go to A&E.

What is cauda equina syndrome?

Cauda equina syndrome is a rare but severe type of spinal stenosis (narrowing of the spine). It can cause a sudden compression of all the nerves in the lumbar region. The symptoms include weak legs, sciatica on both sides, numbness in the crotch or backside, and bladder or bowel issues.

The disorder should not go untreated for six hours as it can result in permanent bladder or bowel misfunction and paralysis.

Most symptoms of mechanical back pain respond to simple treatments such as rest (but do not stay inactive for long), heat or cold packs, heat patches, anti-inflammatory gels and medication, and regular exercise.

When you’re standing, try to stand upright, tilting your pelvis and pulling in your tummy and bottom. Straighten your back and bend your knees while picking something up.

Losing weight can help to get rid of back pain. Eating healthily and drinking plenty of water are also advised.

It is also a good idea to try to address any issues with your posture. We tend to hunch over computers and spend too long at desks and in the car. It’s important to stay active, so take plenty of screen breaks, stretch, and move around at every opportunity.

Mrs Mitchener said: “When we identify that lifestyle is part of the problem, we advise people to adjust accordingly. It could mean using a standing desk, getting up to walk around the room for five minutes, and taking up a bit of exercise — whatever is appropriate to them, whether walking, swimming, or being more active. In non-specific back pain, activity usually helps.”

At The Clementine Churchill Hospital, our physiotherapists may suggest exercises you can do.

Exercises for lower back pain

Exercise that builds up your spine’s flexibility and core muscles will help you to stay active. Start with gentle stretching and exercise to gradually improve your back.

People often ask us, ‘Is walking good for lower back pain?’, ‘Is swimming good for back pain?’, or ‘Is yoga good for back pain?’.

Walking, swimming and yoga are good because they do not cause too much impact and stress on your back and strengthen your core muscles.

You could also try:

  • Stretching exercises
  • Pilates
  • Exercise classes
  • Cycling
  • Dancing

Stop exercising if you feel a new pain or your existing symptoms and pain worsen and talk to a healthcare professional for further advice.

Muscle-related pain like sprains can cause back pain, so a physiotherapist is usually the starting point for most non-specific back pain. They can diagnose disorders in the musculoskeletal system.

Our physiotherapists

Our chartered physiotherapists at The Clementine Churchill Hospital are highly trained, some in the low back, spine, and nerve pain. They can also refer you to colleagues in imaging and recommend a consultant based on what they think is the likely underlying cause of your back pain.

Mrs Mitchener said: “Physios can do an amazing job, but if you are not better in four to six weeks, you should go to your GP or a specialist for further investigations”.

She continues, “Apart from physiotherapy, there are other treatments like medication, injections and surgery. You also benefit from a consultant’s experience and advice about where the issue is going, not least identifying problems, such as osteoporosis, arthritis and other conditions.”

Spinal orthopaedic surgeons & neurosurgeons

Mrs Mitchener recommends seeing a neurosurgeon or orthopaedic surgeon because their speciality is back pain. Any doctor, including rheumatologists and other orthopaedic surgeons, can identify a spinal problem, but then they will send you to a spinal orthopaedic surgeon or spinal neurosurgeon.

She explained: “Neurosurgeons deal with the spinal cord and tumours and orthopaedic surgeons deal with scoliosis. Everything else, we overlap on — but neurosurgeons tend to be more comfortable with neck surgery.”

“We always start with a clinical history and an examination, and about 70% of diagnoses are made at that point,” explains Mrs Mitchener.

“We usually refer a patient for an MRI scan of the spine because there’s no radiation, it’s safe, and we get massive amounts of structural information from it. We sometimes refer people for nerve conduction studies to see which nerves are underperforming, especially if a leg or arm is symptomatic.

“We can refer you for a CT scan or plain X-ray — it depends on what we are looking for, but as there’s radiation involved, we avoid it. We can also refer you for a radioisotope CT scan (SPECT-CT), although they are not commonly used.”

Neurosurgeons and orthopaedic surgeons sometimes refer patients to a neurologist at The Clementine Churchill Hospital for a second opinion if they are unsure about the information they have gathered.

At The Clementine Churchill Hospital, patients may be recommended non-surgical treatments, including injections, medication and physical therapy.

Steroid injections

Our surgeons offer an injection with steroids placed in different ways, which is usually very successful for pain relief. Even after the medication leaves the system, the symptoms mostly do not return.

Surgeons can use injections therapeutically and diagnostically. For example, a scan may indicate that symptoms could arise from two or three levels, but the clinical history and examination aren’t clear-cut for the surgeon to know which level the pain is from. By injecting one, the surgeon can tell whether it’s the right level or not and then treat the pain. The alternative is to inject all the levels, but they won’t know which one to operate on should you require surgery.

Pain medicine

Another treatment is medication, including painkillers like paracetamol, codeine and ibuprofen but also neuromodulators.

The two most used are amitriptyline, which was initially an antidepressant used to dampen nerve pain and pregabalin. As well as pregabalin, there’s gabapentin. Both do the same as amitriptyline but differently and are anticonvulsants.

Physical therapy

Physical therapy would include physiotherapists, chiropractors, and osteopathy.

The following spinal surgeries can be done anywhere in the spine, from the neck to the lumbar area.

  • Microdiscectomy – a treatment involving removing the disc part causing a slipped disc
  • Laminectomy – the surgeon removes bone and ligament tissue to give the nerves and blood vessels more room if you have lumbar spinal stenosis
  • Fusion – spinal fusion connects vertebrae and prevents movement. It relieves pain from several conditions, such as degenerative disc disease and spondylolisthesis
  • Kyphoplasty – kyphoplasty is the injection of medical cement into a collapsed vertebra, usually due to osteoporosis
  • Foraminotomy – a general term for relieving pressure on the nerve root in its bony tunnel
  • Denervation – an injection treatment that destroys the pain-supplying nerves in the spine's joints. They regrow over about a year. You get a more extended period of pain relief, and the pain may not return

The following surgery is for the neck only:

  • Anterior cervical discectomy and fusion – a specific procedure for the neck and commonly performed at The Clementine

The Clementine Churchill Hospital in Harrow has all the latest equipment required for multiple surgeries and treatments for back pain, including radioisotope CT SPECT scans.

It also has all the expertise you need from highly experienced clinicians, including orthopaedic surgeons, neurophysiologists, neurologists, and rheumatologists.

At The Clementine Churchill Hospital, Harrow, our friendly team is always on hand to provide information, advice and reassurance.

If you’re experiencing back pain and would like more information about possible treatment options, you can book your private consultation online or give us a call on 020 8872 3872

We look forward to welcoming you to The Clementine Churchill Hospital.

Specialists offering Back pain

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Dr Shahir Hamdulay

Consultant General Internal Medicine & Rheumatology

B.Sc, Ph.D, MBBS, MRCP

The Clementine Churchill Hospital 1 more Hendon Hospital

View profile Book online

Prof Hasan Tahir

Consultant Physician in Rheumatology & Acute medicine

BSc, MB BS, D Sports-Ex Med, MSc, MFSEM(UK), FRCP(UK)

The Cavell Hospital 2 more The Clementine Churchill Hospital The Kings Oak Hospital

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Mr Hilal Fareed

Consultant Orthopaedic Surgeon

MBBS, D Orth, M S, M Ch Orth, FRCS (T&O)

The Clementine Churchill Hospital 1 more Syon Clinic

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Dr Bela Vadodaria

Consultant in Pain Management and Anaesthesia

MBBS, FFARCSI

The Clementine Churchill Hospital

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Mr Shaun Ridgeway

Consultant Orthopaedic, Trauma and Spinal Surgeon

MBChB, MRCS, FRCS (Orth)

The Clementine Churchill Hospital

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Mrs Anne Mitchener

Consultant Neurosurgeon

BSc, PhD, MB BChir, FRCS, FRCS(SN)

The Clementine Churchill Hospital

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